This grant proposes to extend the use of state of the art neuroimaging techniques to the study of brain injury in preterm neonates. Currently, ultrasound is the technique most commonly used to image the brains of preterm neonates; however, ultrasound detects fewer than one third of the white matter lesions detected at autopsy and by MRI. Furthermore, ultrasound findings do not account for the neurodevelopmental problems that have been reported in up to 50% of prematurely born infants. Preliminary studies show that magnetic resonance (MR) imaging is safe in preterm neonates, that anatomic MR imaging has greater sensitivity than ultrasound in detecting noncavitary white matter injuries in preterm neonates, and that diffusion tensor imaging (DTI) and MR spectroscopic imaging (MRSI), which assess the microstructure and metabolism of the developing brain, are very sensitive to disruption of normal development, particularly when sequential studies are performed. This grant will extend these preliminary studies (1) to determine whether alterations of cerebral metabolism, as assessed by MRSI have a stronger association than standard clinical and laboratory parameters with 30 month motor, visual, and cognitive outcome as assessed by neuromotor, ophthalmologic examination, and Bayley's Scales of Infant Development II, (2) to determine whether alterations of cerebral microstructure, as assessed by DTI, have a stronger association than standard clinical and laboratory parameters with 30 month motor, visual, and cognitive outcome assessed by neuromotor scores, ophthalmologic examination, and the Bayley Scales of Infant Development II, and (3) to determine whether alterations of cerebral metabolism, as assessed by MRSI, or alterations of cerebral microstructure, as assessed by DTI, has a stronger association with 30 month neurodevelopmental outcome, as assessed by neuromotor score, ophthalmologic evaluation, and the Bayley's Scales of Infant Development II.